Provider Demographics
NPI:1104249994
Name:ROSS, HEIDI (LMHC, SUDPT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:LMHC, SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 NE KRESKY AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2412
Mailing Address - Country:US
Mailing Address - Phone:360-330-9595
Mailing Address - Fax:360-330-9560
Practice Address - Street 1:117 RAMSEY WAY
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:WA
Practice Address - Zip Code:98591-9445
Practice Address - Country:US
Practice Address - Phone:360-864-4400
Practice Address - Fax:360-330-7865
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60911212101Y00000X
WALH60700309101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2110851Medicaid
TX843LQFOtherBCBS OF TEXAS